Indivina

Indivina tablets are a form of HRT containing the active ingredient estradiol, also known as oestradiol in some parts of the UK. The other active ingredient of Indivina is medroxyprogesterone. These two substances combined are used to overcome some of the more common symptoms of the menopause.

Indivina is a form of hormone replacement therapy (HRT) medication, used to tackle the common symptoms that occur during various phases of the menopause, when a woman's oestrogen levels begin to diminish with age. When oestrogen levels fall, the result can be night sweats, hot flushes, irregular periods, vaginal dryness, mood swings and other side effects. The oestrogen substance in Indivina, estradiol, helps to replace the reduced levels of oestrogen in the body.

However, to reduce the risk of an increased threat of cancer caused by the thickening lining of the womb, a dose of progesterone is also needed. In this case, medroxyprogesterone is used as a replacement for natural progesterone. In women who have had their womb removed through a hysterectomy, it is not necessary to have progesterone as well as oestrogen in an HRT treatment.

Indivina is just one of the many forms of HRT available for women who have not had a hysterectomy following the beginning of menopause. Indivina tablets are a continuous form of combined HRT, where the body is consistently exposed to the same dose of oestrogen and progesterone every day. This type of HRT does not lead to a monthly bleed similar to other treatments.

Doctors will typically only prescribe Indivina HRT to women who have already stopped having regular periods. It is unlikely that you will be given this medication unless you have not had a period for three years or longer. In many cases, the reduction of oestrogen in the body can also lead to increased issues with bone loss and osteoporosis. Because postmenopausal women are more likely to suffer from osteoporosis, Indivina HRT can be used as a treatment to protect against this problem, and also reduce the risk of fractures as the bones start to become fragile, brittle, and more prone to breaking. When you begin taking Indivina, your doctor will ask you to agree to regular medical check-ups to ensure that you are not having any negative reactions to the substance.

Indivina is a continuous form of HRT. This means that you will usually be asked to take a single Indivina tablet once a day for a long period of time. You will not need to take any breaks between packets of Indivina HRT as you would with a contraceptive pill. However, it is important to remember that regular check-ups are necessary with Indivina. Your doctor will review whether you should continue taking this substance after a year.

Indivina tablets can be taken by mouth with a glass of water or another non-alcoholic drink, with or without food, although some people find that it is easier to take them with food as this will remind them when to take their tablet each day. Similar to the contraceptive pill, it is important to take Indivina HRT at the same time each day whenever possible, as this will improve the effectiveness of the medication. If possible, set an alarm that will remind you to take your dose on time.

Only one dose of Indivina HRT is available on the market today, containing 2.5 mg of the combined hormonal substances used to control your menopausal symptoms. Most women taking Indivina HRT will be asked to take one tablet a day continuously, although your doctor might adjust your medication strategy according to the way that your body responds. If you forget to take your daily dose of Indivina HRT at the time you would usually take it, it is important not to double up. You can simply skip the forgotten dose and take the next dose as usual. If you are concerned about missing a dose, or if you have vomiting or diarrhoea soon after taking Indivina HRT, speak to your doctor about your options.

All HRT treatments, including Indivina tablets, can have side effects. This substance may affect different people in unique ways, so it is important to remember that the following list might not include all of the symptoms that you may feel. If you notice anything unusual about the way you feel when taking Indivina HRT, stop taking it and contact your doctor immediately.

Some side effects that may occur when taking Indivina include:

• Breast enlargement, tenderness, or pain;
• Nausea and vomiting;
• Abdominal pain or bloating;
• Indigestion and flatulence;
• Menstrual spitting or bleeding;
• Migraine or headaches;
• Fluid retention and swelling;
• Increased size of uterine fibroids;
• Premenstrual symptoms such as mood swings and pain;
• Mood changes such as irritability, anxiety and depression;
• Changes in sex drive;
• Fatigue and dizziness;
• Sudden weight changes;
• Rises in blood pressure;
• Leg cramps;
• Changes in the corneal curvature which may make it difficult to wear contact lenses;
• Skin reactions such as itching and rash.

Some women taking Indivina HRT notice brown patches of skin, usually around their face. There are also some more serious side effects that can occur as a result of taking Indivina HRT, including an increased risk of gallbladder disease and inflammation of the pancreas. Some women who take Indivina will also be more likely to experience blood clots, which can lead to heart attacks, strokes and pulmonary embolism.

If you notice any changes in your liver function which lead to a yellowing of the skin or eyes, contact a doctor immediately. Make sure you seek emergency medical attention if you notice signs of an allergic reaction, such as trouble breathing, or swelling around the throat, face or tongue.

Most women will be able to use Indivina HRT safely without any negative side effects. Women with a suspected or known history of breast cancer or cancer where the issue might be stimulated by the presence of additional oestrogen should also avoid taking Indivina tablets. If you have an untreated overgrowth in the lining of your womb, this will not be the right treatment for you, while women with blood disorders that increase their risk of clotting may be at greater risk when taking Indivina HRT.

Your doctor will usually not prescribe Indivina tablets if you have conditions such as:

• Vaginal bleeding where the cause is not known;
• Inflammation of veins caused by blood clots;
• Blood clots deep in the vein of the leg or in the lungs;
• Previous instances of stroke, heart attack or angina;
• Liver disease or a history of liver problems where liver function has not returned to normal;
• Inherited blood disorders.

If you are pregnant or breastfeeding, you should not take Indivina HRT. Additionally, it may not be appropriate to take this medication if you have a galactose intolerance, or a problem with glucose-galactose malabsorption.

If you have any allergies to any of the substances in Indivina tablets, make sure that your doctor is aware of this before you begin using the medication. Before taking any new HRT treatment, it is important to have a discussion with your doctor that covers your complete medical history and that of your family.

You will also need to talk to your doctor about any medicines you are taking besides Indivina HRT as there can be interactions between various different kinds of drugs. This will include mentioning any herbal remedies or supplements that you are taking, alongside prescription medications and medicines that you can buy over the counter.

Some of the medicines that might interact negatively with Indivina HRT include those used for the treatment of:

• Epilepsy and fits such as carbamazepine and phenytoin;
• Tuberculosis such as rifabutin and rifampicin;
• HIV infections such as ritonavir and nevirapine, as well as those the herbal substance St John’s Wort.

In some cases, taking Indivina tablets can also affect the way that drugs used for the treatment of diabetes work. Your doctor will ask you to take regular readings of your blood glucose levels to make sure that you do not need to adjust your treatment when taking Indivina. Additionally, it is possible for the Indivina tablets to interact negatively with substances used to reduce blood pressure. Usually when given HRT by your doctor, they will ask you to commit to regular blood pressure tests, as well as general medical reviews to ensure that none of your medications are interacting poorly. Your doctor will assess the risks of prescribing Indivina tablets to you if you are taking any other medications carefully.

It is possible to buy HRT pills and substances such as Indivina online or offline from an authorised pharmacy. Remember that Indivina tablets are a treatment that can only be prescribed by a doctor. You should never purchase this substance from a store that promises to give it to you without a doctor’s prescription, as this could be very dangerous.

All HRT treatments require a prescription from your doctor. Only your doctor will be able to assess your medical condition and medical history to ensure that Indivina is the right treatment for you. You should not try to purchase or use Indivina tablets without a prescription, as they could react dangerously with other medications, or may not be suitable for your condition.

NICE, 2018, Indivina Tablets online, [accessed 19 June 2019], available on: https://bnf.nice.org.uk/clinical-medicinal- product-information/indivina-tablets.html

Orion Corporation, 2018, Indivina 1mg/5mg tablets, Online [accessed 19 June 2019], available on: https://www.medicines.org.uk/emc/product/4066/pil